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Thursday, November 20, 2014

Kids and Antipsychotics: A Cautionary Tale

From the Child Mind Institute Blog

By Caroline Miller
November 17, 2014

The New York Times ran a disturbing story over the weekend (see below) about a mother weighing whether to put her 6-year-old son on Risperdal, along with the stimulant he's taking for ADHD. It's disturbing because putting young children on two medications, especially if one is an antipsychotic, is scary.

But it is also disturbing because neither the reporter nor the doctors interviewed addressed the question that should be asked before any treatment is prescribed: What might be behind this boy's problem behavior?

The boy, named Matthias, has mysterious rages, refuses to join activities, and bolts from "adults trying to corral him." This sounds a lot like anxiety. He refuses to do math and word problems in school, and puts his head down on the table. Has he been evaluated for a learning disorder?

He melts down when his mother parks in the wrong spot—could he be on the autism spectrum? Does he "explode into fits of anger and despair" because he has sensory issues? There's chaos in Matthias's home life. Might trauma be a contributing factor?

There isn't one voice in this story that reflects best practices in treating a child like Matthias. Before even considering prescribing a powerful drug like Risperdal, a clinician should explore what's going on with this child, whether the initial ADHD diagnosis is correct, and whether structured behavioral interventions would help him.

Instead, Matthias's mother is considering putting him on an antipsychotic so he can avoid special education classes. And the pediatrician treating him makes this lame joke in lieu of a diagnosis: "He's got MSD—Matthias Specific Disorder."

This is a textbook case of why you need to try to understand behavior, not just try to control it.

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